At the BSO clinic as a student observer, I observed a patient who sustained a fracture to her first metatarsal on her left foot. Miss Cole, a 21 year old female said she had acquired this injury through playing tennis a few weeks ago. She has been playing tennis professionally since she was a child but due to studies, she can now only play for leisure. A week ago, she took off her foot cast, but due to her injury the patient explains that she still feels a great deal of fatigue and pain in her lower extremity (hip, and both legs).
The patient expressed localised pain at the metatarsal phalangeal joint and said the pain increases with movement and eases with rest. She said she felt some stiffness due to not being able to move the toe and mentions
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The affected area was also warm to touch.
On examination the patient expressed pain with resisted plantar flexion and dorsal flexion and she wasn 't able to fully invert her left foot passively. However there was normal, active and passive movements of the right foot. Examination of the hip showed patient felt some ‘stiffness’ with active moments around the anterior thigh muscles but due to normal flexion/extension of the leg the osteopath ruled out any femoral or sciatic nerve damage from the injury.
The clinical significance of these observations helps us to understand the effects of her injury on the rest of her lower extremity. Because of the strain and all the weight bearing on her right foot, Miss Cole is now experiencing fatigue in her calf and anterior thigh muscles . Due to the strain on her lower extremity the treatment plan included a calf pumping treatment to get the blood circulating and to loosen up the gastrocnemius and soleus muscles. Miss Cole is advised to try and not put all her weight on her right foot as it will cause her more fatigue . Immobilisation is recommended so the fracture can heal completely, but because Miss Cole is training for a competition, other options are recommended. For example, applying hot and cold packs to the affected area may help relieve some of the bruising and